Provider Demographics
NPI:1922152214
Name:ZION FAMILY CARE HOME CORP
Entity Type:Organization
Organization Name:ZION FAMILY CARE HOME CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:BASIL
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-452-7716
Mailing Address - Street 1:101 KNOTHOLE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6112
Mailing Address - Country:US
Mailing Address - Phone:919-452-7716
Mailing Address - Fax:919-425-1683
Practice Address - Street 1:101 KNOTHOLE LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-6112
Practice Address - Country:US
Practice Address - Phone:919-425-1683
Practice Address - Fax:919-425-1683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL032084310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility